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21 Cards in this Set
- Front
- Back
Kroenke & Price (1993)
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- Large community sample
- Lifetime prevalence of 26 common symptoms - 31% no medical diagnosis or explanation |
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Koch et al. (2009)
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- MUS tend to persist for long time
- 43% of 254 patients with unexplained fatigue, abdominal or musculoskeletal complaints still had complaints (still unexplained) 1 year later -People with lots of persistent MUS tend to consult doctor a lot - “frequent attenders” |
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Simon & Vonkorff (1991)
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- Study of co-occurrence of MUS and psychiatric symptoms in large community sample
- More MUS: greater likelihood of anxiety and depression symptoms |
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Somatization
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- Psychological distress expressed as physical symptoms
- Patients feel symptoms are delegitimised - Little evidence |
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Attributional Style
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- Normalising: environmental causes
- Psychologising: psychological causes - Somatic: illness causes - Kirmayer & Robbins (1991) |
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Pawlikowska et al. (1994)
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- Fatigue symptoms positively correlate with distress
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Rejecting Explanations
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- Dr denies reality of symptoms, implies its imaginary disorder
- Cause distrust of Dr - Salmon, Stanley, Peters, BMJ (1999) |
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Colluding Explanations
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- Dr agrees with patients explanation
- Causes patients to question Dr's openness and competence - Salmon, Stanley, Peters, BMJ (1999) |
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Empowering Explanations
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- Dr suggests tangible mechanism as explanation, free from guilt with opportunity for self-management
- Legitimizes patients suffering, removes blame - Allies Dr and patient - Allows for discussion of psychological features - Salmon, Stanley, Peters, BMJ (1999) |
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Kroenke & Swindle (2000)
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- Systematic review of 31 controlled trials of CBT for MUS
- 12 month improvement compared with treatment as usual in: – Physical symptoms – Functional status – Emotional distress |
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Reattribution Therapy
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- Adaptation of CBT to primary care
- Stages: 1) Feeling understood: explore illness belief, respond to emotional cues 2) Broadening the agenda: exploration of emotional factors 3) Making the link: e.g. Stress response, muscle tensions 4) Collaborating on a treatment or management approach |
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Morriss & Gask (2002)
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- 150 patients before GPs trained compared
with 150 patients after training - Improvements in patient satisfaction and decrease in patient somatizing beliefs - BUT, no benefit of reduction in healthcare use |
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Chronic Fatigue Syndrome
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- Over 6 months of severe, disabling fatigue
- Significantly affects work, social and leisure functioning - Additional symptoms: pain, sleep problems, memory and concentration problems |
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Puetz (2006)
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- Active people less likely to experience fatigue than sedentary people
- Association is robust - Activity precedes feelings of greater vigour - Dose-response relationship |
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Dysregulation Hypothesis of Chronic Fatigue Syndrome
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- Reduced activity levels leads to:
- Deconditioning (adapting to inactivity) - HPA axis (stress hormones) dysregulation - Sleep disturbance - THEN, difficulties when activity resumed leading to fear and demoralisation |
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White et al. (2011)
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- Graded exercise therapy and CBT more effective reducing fatigue and improving physical functioning than adaptive pacing therapy or standard medical care
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Moss-Morris et al. (2005)
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- Improvements in fatigue after graded exercise therapy mediated by decreased symptom focusing
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Wearden & Emsley (2013)
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- Improvements in fatigue after graded exercises therapy mediate by decreased activity limitation and catastrophising
- Not increased fitness |
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Mindfulness Based Stress Reduction (MBSR)
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- Used to treat chronic pain (e.g. chronic widespread pain and fibromyalgia)
- Seeing self in context - Awareness of own experiences without too much attachment; accepting and non-judgemental - Kabat-Zinn (1994) |
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Cognitive Behavioural Model of Chronic Pain
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- 'Fear-avoidance model'
- Non-threatening interpretation = lower fear, confrontive coping, maintaining activity, recovery and reduced future pain - Catastrophising interpretation = fear, avoidance of activity, physical disuse, disability, depression, more likely to experience pain |
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Schutze et al. (2010)
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- Measured all aspects of fear avoidance model
- Greater mindfulness associated with lower pain intensity, disability, negative affect, catastrophizing, fear and hypervigilance - When other variables controlled for, only mindfulness predicted lower catastrophizing (which predicts lower pain) |